NCCP Extravasation Classification of Systemic Anti-Cancer Therapy

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NCCP BACKGROUND DOCUMENT EXTRAVASATION CLASSIFICATION OF SYSTEMIC ANTI-CANCER THERAPY

Version Date Amendment Approved by

1 21/06/2017 Version 1 NCCP 2 21/11/2019 Document reviewed to: NCCP 1. Amendment of MOCIS to NCIS 2. Inclusion of tallman lettering 3. Addition of avelumab, atezolizumab, blinatumomab, dinutuximab, durvalumab, inotuzumab, ramucirumab, vinflunine,

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NCCP Background Document 0010| Extravasation Classification of SACT| V2| 2019

Background

Drugs used in Systemic Anti Cancer Therapy (SACT) particularly cytotoxics, can be extremely irritating and cause damage if they extravasate or infiltrate into surrounding tissues during intravenous administration. Extravasation refers to the inadvertent infiltration of any liquid (fluid or drug) from a vein into the subcutaneous or subdermal tissues during intravenous administration (1). Depending on the type, extravasation can result in damage to the tissues, cause pain, erythema, swelling and blistering. If left undiagnosed or inappropriately treated, this can lead to necrosis, secondary infection and functional loss of the tissue or possible permanent damage to the limb involved (2).

Management of an extravasation depends on which drug has accidentally leaked into the tissues. Therefore, it is vital that the classification of the drug is known in order to direct the management of the extravasation.

Currently, most hospital delivering HSE funded SACT services maintain their own extravasation classification lists and there are some variations between hospitals. The introduction of the National Cancer Information System (NCIS) presents a potential opportunity to implement a series of standardised documents for inclusion within the (NCIS) configuration. The NCCP has developed a standardised nursing document for the assessment of a suspected or diagnosed extravasation injury and an accompanying list of extravasation drug classifications for use in Irish hospitals and if possible, for inclusion within the NCIS configuration. The extravasation classification list is based on current International evidence (3-15).

The NCCP extravasation classification list (Appendix 1) will classify parenteral SACT into four different types depending on their ability to cause local damage after extravasation. These categories should be implemented in all future extravasation recording documentation and electronic systems where possible.

 Vesicants DNA Binding  Vesicants Non DNA Binding  Irritants  Neutrals (Non vesicants)

As per the NCCP Oncology Medication Safety Review Report (16), each hospital is required to have a policy governing the prevention, recognition and treatment of extravasation. This should be developed in line with local practices and incorporate references to the documentation as described above.

This document is based on internationally accepted guidance on the extravasation classification of drugs. Any clinician seeking to apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. Please refer to local hospital extravasation policy for more details on the treatment of extravasation Use of this document is the responsibility of the user and is subject to HSE’s terms of use available at http://www.hse.ie/eng/Disclaimer This information is valid only on the day of printing, for any updates please check https://www.hse.ie/eng/services/list/5/cancer/profinfo/medonc/sactguidance/ NCCP Document 0010 Extravasation Classifications Published: 21 June 2017 Version: 2 of Systemic Anti Cancer Therapy Review: 21 November 2022 Page 2 of 4

NCCP Background Document 0010| Extravasation Classification of SACT| V2| 2019

Appendix 1. Extravasation Classification of Systemic Anti-Cancer Therapy

Vesicants Vesicants DNA Binding Vesicants Non DNA Binding Amsacrine EpiRUBicin PACLitaxel VinBLAStine Bendamustine IDArubicin PACLitaxel NAB VinCRIStine Carmustine Mechlorethamine Vindesine DACTINomycin MitoXANTRONE Vinfluine DAUNOrubicin MitoMYcin C Vinorelbine DOXOrubicin Trabectedin VinBLAStine Irritants Arsenic trioxide CISplatin Flourouracil Streptozocin AzaCITIDine Dacarbazine Gemtuzumab Ozogamicin Teniposide Bortezomib DOCEtaxel Ifosfamide Temsozolomide Busulfan Liposomal DAUNOrubicin Irinotecan Topotecan Cabazitaxel Liposomal DOXOrubicin Melphalan Trastuzumab Emtansine (Kadcyla®) CARBOplatin Etoposide Oxaliplatin Streptozocin Non Vesicants/Neutrals Aflibercept Cetuximab Inotuzumab Pemetrexed Aldesleukin Cladribine Interferons Pentostatin Alemtuzumab Clofarabine ipilimumab Pertuzumab Amifostine Cyclophosphamide Methotrexate Pixantrone Asparaginase Cytarabine Mifamurtide Raltitrexed Atezolizumab Daratumumab Nelarabine Ramucirumab Avelumab Decitabine Nivolumab RiTUXimab Bevacizumab Dinutuximab Obinutuzumab Ruxolitinib Bleomycin Durvalumab Ofatumumab Siltuximab Blinatumomab EriBULin Panitumumab Temsirolimus Brentuximab-vedotin Fludarabine Pegaspargase Thiotepa Carfilzomib Gemcitabine Pembrolizumab Trastuzumab (Herceptin®)

NCCP Background Document 0010| Extravasation Classification of SACT| V2| 2019

References 1. Fidalgo J.A, et al. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice. Guidelines. Annals of Oncology 2012; 23: 167-173. 2. NHS East Midlands. Guidelines for Management of Extravasation, 2015. 3. Quicklinks table, eviQ Extravasation Management, 2019. 4. Extravasation Guidelines Implementation Toolkit, EONS 2007. 5. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. 6. Chemotherapy extravasation guideline, WOSCAN 2009. 7. Assessment, Prevention & Management of Extravasation of Cytotoxic Medications GONG Cancer Care Guidelines 2009. 8. Extravasation policy for all drugs, chemotherapy & non chemotherapy, NHS Tayside, 2008. 9. Policy for the Treatment of extravasation Injury, NHS, Avon, Somerset and Wiltshire 2012. 10. Guideline for Management of Extravasation, NHS East Midland, 2018. 11. Extravasation Hazard Table, BCCA 2019. 12. Guidelines on Treatment of extravasation with Cytotoxic Drugs, NHS Thames Valley 2014. 13. Policy on the Management of Extravasation, Network Site Specific Group 2016. 14. Extravasation injury from chemotherapy and other non-antineoplastic vesicants, UpToDate 2017. 15. Cancer Care Ontario Drug Formulary. 16. NCCP. Oncology Medication Safety Review Report 2014.